What is the role of sclerotherapy in the treatment of a hydrocele?

Updated: Oct 28, 2020
  • Author: Jacob C Parke, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

An additional adjunctive, if not definitive, procedure, is scrotal aspiration and sclerotherapy of the hemiscrotum using tetracycline or doxycycline solutions. Recurrence after sclerotherapy is common, as is significant pain and epididymal obstruction, making this treatment a last resort in poor surgical candidates with symptomatic hydroceles and in men in whom fertility is no longer an issue.

A review by Taylor et al of aspiration and sclerotherapy treatment for hydroceles in aging men concluded that sodium tetradecyl sulphate (STDS) is the sclerosing agent with the best cure rate after a single injection and rates of adverse effects. Cure rates with STDS were 76% after a single aspiration and injection and 94% after multiple treatments. Patient satisfaction rates at a mean of 40 months were 95%. Complication rates were generally low and much lower than those seen with surgical repair. [17]

Lund et al, in a study of 76 patients with hydrocele testis, found that aspiration and sclerotherapy with polidocanol is an effective treatment with a low recurrence rate. In this prospective, double-blind, randomized study, 36 patients given polidocanol (group 1) were compared with 41 patients given placebo (group 2). Recurrence after the first treatment was seen in 16 (44%) of the polidocanol patients and in 32 (78%) of the placebo patients. Recurrence after re-treatment with polidocanol in both groups was seen in four patients (25%) in group 1 and in 14 patients (44%) in the former placebo group. The overall success rate of treatment in group 1 was 89%. [18]

Jahnson et al reported that in patients undergoing sclerotherapy, adjuvant treatment with an antibiotic and a nonsteroidal anti-inflammatory drug resulted in an increased cure rate and a lower incidence of subclinical epididymitis/swelling (SES). In their prospective observational study of 191 men who underwent polidocanol sclerotherapy for hydrocoele/spermatocoele, the patients who received anti‐inflammatory medication after the procedure had a decreased rate of SES (5% vs 26%) and an increased cure rate (96% vs 88%), compared with those who did not receive anti-inflammatory medication. The usual regimen in the treatment group was trimethoprim 160 mg (occasionally ciprofloxacin 500 mg) twice daily and diclofenac 50 mg three times daily for 10 days. [19]


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